46D2261257 CLIA NUMBER - RIVERSIDE MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 46D2261257
  • Facility Name: RIVERSIDE MEDICAL CENTER
  • Facility Address: 3152 N UNIVERSITY AVE
    PROVO, UT
    ZIP 84604
  • Facility Phone: 801 437-4895
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS FJELDSTED
  • NPI Number: 1649567504
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D2261257
LAB Type Physician Office
Facility Name RIVERSIDE MEDICAL CENTER
Street 3152 N UNIVERSITY AVE
City PROVO
State UT
ZIP 84604
Phone 801 437-4895
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/27/2024
Certificate Expiration Date 5/26/2026
Facility Type Physician Office
Lab Director THOMAS FJELDSTED

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This page was last updated on: 9/29/2025